Innovative journey of a multidimensional medical practitioner

1. Being a surgeon, innovator and also a stand up comedian represents three different aspects of the same person. What has inspired you to be a part of all of them with equal enthusiasm?

Yeah, so I think for me, they are not different things.I have had a lifestyle since, since a child so even when I was a kid I think almost from the age of seven years. I have always been into theater and be doing plays for all my life and a lot of us do that we are all a part of a theta club or a dance club or, some sports.The only difference is by around eight or nine or 10. When we are exams and education, takes the priorities. These things take the backseat. The only thing that I did is I continued them all the way into my clinical practice time. So through my meds college as well as my post graduation college. I used to be constantly involved in theater. So for me, these three things being a surgeon was primary always wanted to be a doctor so I think that was the career choice that I took. But being an innovator and a stand-up comedian were evolutionary outcomes of the circumstances I was, I was facing. So, for me as a doctor I feel for a doctor to invent is an extension of what a doctor should do, because while I was seeing patients, there were many times where I was not able to offer any good solution to the patients, and being the front end, alking to the patient and not being able to offer solutions like for example we are examining people with throat cancer rural areas were not able to see, you’re not able to biopsy you’re not able to examine. And then we have to say that this is all that we can do when I was very not comfortable saying something like that so.

So I felt as a doctor, you don’t only have to see patients or contribute to research, but he’s also enable. And what I did in trying to invent early on during my post graduation itself was merely just an extension of what I felt I should do as a doctor because I was unable to provide the best care, but as my clinical practice grew theatre started taking a bit of a, hit because Pater requires many months of rehearsals and a huge team, and a lot of commitment, while it was fine till I was studying because your academic calendar is not very unpredictable. But when I started practicing as a private practicing doctor. You can have patients anytime in the day, you can have surgeries emergencies anytime in the day, and I was unable to make time for these rehearsals, and I ended up being that actor who would commit but not be there for the rest of the whole team suffers. And I would get the main roles, but I would not do all of these rehearsals and then, it was almost blacklisted from any theater groups. So stand up comedy at that point of time in 2015 was growing to be a field where you get to be on stage, you get to be someone you get to do comedy or you get to play a character but stand up comedy interestingly takes away the need for rehearsals with a group, because the stand up comedy comedy is a solo job.

Do you need a team, but you don’t need to rehearse with the team. , like theatre demands, you can write it in your own time, you can practice it in your own time, you can perform it and you can improve your art, and that suited well with my clinical role, and the innovation arm that was growing, and that’s why being a surgeon innovator and a stand up comedian ended up being somewhat an evolutionary balance that I had to do to, to be able to keep my passion alive and as well be an effective doctor and a holistic doctor.

2. After the COVID-19 phase, is there any change in the scenario of stand up comedians?

Yes, actually so COVID-19. When the pandemic started, it was a big hit for live shows.I was almost doing about an average of 10 to 12 shows a month, and largely corporate shows current medical conferences, college shows and, and also  for for schools.So, when the pandemic hit all the live shows completely got got stopped and then we were to adapt to a newer form of comedy which is what you will. Now, what happened is the dynamics changed drastically. Because when you are performing live your competition is only the comedians who are in that city. When you are performing virtually, you are competing with every comedian in the world because anybody can also perform live at the same time. So certainly for medical conferences or for organizers, their options widened, but at the same time, the options widened for the audience also because they could only go and see shows that were there in the city now they can attend any community in any way. That is one aspect that changed a lot of the dynamics for stand up comedy The second aspect was to perform virtually, which is very difficult in a field of comedy because, the live audience cannot mute itself, where a live audience cannot suddenly disappear. And then the live audience is all in one room you can control the room you can control the energy of that room.

You can build the energy in that room here everyone is sitting in their own independent rooms where there are different energies, there are different distractions, and they can get a call, they can mute, they can disappear and and and  that took some time especially for many comedians. Stop doing stand-up comedy, because of the pandemic because they could not adjust to, which will show us. For me, on the other hand, coming from a theater background, and having a lot of experience with people, where I was able to somehow figure out some nuances to make that work. And in fact, I started doing more virtual shows more virtual stand up comedy than I was doing live, because now there is no travel element, and you can do multiple shows in a day, like I remember at one day I did, I did about nine shows in a day. And that used to be something that I would probably do in a month, because it’s just from one zoom link to the other or a Microsoft team link to other and with a gap of one or two hours, and you have a new audience on your screen. And, and in this pandemic, I’ve done over 200 shows just virtually, though it does not give you the feeling of an actual live audience, but I think now we’re able to get as close as possible because now we know what to do, what to say what to ensure that the audience gives the same flavor. And if you,  see any of the virtual stand-up comedy’s that I’ve conducted recently. They are just as good as live in terms of the reactions and laughs clubs and closes with the only thing is that you’re not there in one room and you still have to see each other’s faces, next to each other.But having said that, I think it has helped artists grow and artists who could hustle and survive the pandemic figure out ways to survive. It also eliminated the week, so the survival of the fittest holds true even for comedians.And now I think we have better comedians to have a lot of content and they can make people laugh, whether they’re in front of them are very far away as well.

3. From an Indian perspective what are hurdles you have faced while following passion and profession?

Yeah, honestly I did not really face many hurdles from this balancing act, especially from my family. So my father’s a psychiatrist mother’s a teacher and my father has also been an actor while doing his medicine. So, art has always been encouraged. I grew up in Bangalore and Bangalore has very strong theatre roots, especially at the school level.Most people from Bangalore are usually a part of some of the other theatre or dance groups even at a professional level.And I was just like everyone else. So, for me to be studying and following my passion, really has never been a big hurdle for my parents they were not the kind you said that you can follow your passion later focus on your studies. I think when we tried that though at some important aspects of our studying life, my performance came down whenever I would not take part in certain extracurricular activities and I think my parents were soon to realize that that’s an important part of my well being, both mentally as well as in my outcomes. So from my immediate family never have had any hurdles.

When I, as a professional there were some hurdles but that didn’t seem to bother me because it’s generally when you are an artist you used to criticism much earlier on, and you used to improvising also a lot, so, even though I had colleagues or professors or teachers who would say things like, you’re a surgeon or you’re inventing you wasted a medical seat because they assume that inventing is a totally different thing and being a doctor is a totally different thing. So they feel that okay if you’re inventing you stop becoming a doctor or, if you’re doing comedy, my colleagues would say, yeah you’re, as long as you’re doing that it’s fine as theatre has got some elegance to it. But you’re doing comedy to “joker ke pass kaun patient aye” who will come to a joker as a patient. What is the perspective there so I got to face that early on, I don’t get that at all anymore. In fact, I get the same doctors now wanting to invent and also same colleagues wanting to try out comedy, but early on I did have that because whenever you do something offbeat whenever you do something that is not the norm people who have been hustling with those same questions in their mind but they have chosen, their profession will also question you because that’s probably why they didn’t do what they wanted. So they asked you also why are you doing like this but for someone like me is you have not, not a topper I don’t have very high stakes, an average kid, and I try a lot I fail a lot, and I cope up a lot. So for me it’s not very disturbing to hear things like this in fact it kind of gives me a direction that is okay if I’m going off beat. That means there will be less competition here and I’ll be able to create a space for myself.And I know when I look back at it I asked my patients.

Why do you come to a joker? And my patients say that, serving us when you did comedy and we connected to a joke. We feel we’ve connected with you at a human level and you’re less likely to cheat us otherwise this image of doctors, especially in the corporate world that you don’t want to take you two surgeries and want to take your money. We feel that you’re probably not the kind of person because we’ve already connected beforehand. And that’s a very interesting insight because my patient floats almost doubled or tripled. As some of my comedy picked up and not only that, post my comedy sessions people would line up I thought they’re taking selfies, and then until they take out the CT scans and start showing me their sinuses, and my surgeries also increased. And similarly with the medical community being an innovator. I now get a chance to work in many other fields, even though I’m an ENT but my inventions and the inventions that have been supported across various clinical fields so I think holistically, these hurdles have made me probably a doctor with wider knowledge and experience, and an artist, with wider knowledge and experience.

4. The recent pandemic has taught us a lot. Kindly share any anecdotes that you would love to share with our readers that have motivated your thoughts.

Yeah, so the recent pandemic. One of the things that it was doing to me as a doctor was that people remotely wanted to see the care, but being in a surgical field it is very hard to provide definite of care. And, like I had a patient from Raipur who wanted to travel to Bangalore for a consultation, but because of the pandemic the patient could not. And I was not able to do anything beyond the video call and the patient had issues in the ear, but I could not see inside the ear so I was trying to guess and wasn’t sure whether it will worsen and all of that. And that made me think that we need to find a way to make tele examination happen now because teleconsultation may work very well for things like radiology pathology or many medicine fields where they are chronic noncommunicable diseases, where you can do a set of lab tests, you can get basic parameters like pulse rate, BP, temperature. Many of these devices are there at homes of people even oxygen saturation for that matter so a lot of these parameters are easily accessible so for those fields that works but for surgical fields like mine. If you do not see inside the ear, nose, and throat.

There is not much that you can do in your diagnosis, and in your treatment so now what we have done and that that is what the pandemic has taught us is that we have now developed a technology, where we are now able to remotely carry out examination so I just recently saw the same patient from Raipur by sending a device to their house and they were able to place that device into the ear they were able to place a device into their nose in their oral cavity, I could see the majors very clearly sitting here in Bangalore on my computer, and I was able to make a diagnosis and treatment for them. And are we willing looking at doing this in a larger way? But that’s definitely something that the pandemic has taught and has motivated, motivated me and my team to think about living with the current situations where patients are scared to come to the hospital. Patients may not be even permitted to travel many times, and vulnerable patients like kids, older people may not find it safe to visit contagious areas like hospitals, and for a surgeon if you’re not able to examine you will not be able to treat them. And I think tele examination is going to be the future for a lot of surgical fields to be able to do the workup entirely offline and see the patient directly in the preoperative area, operate the patient send them back, and then again follow up remotely. And that’s a big realization and we’ve been able to motivate ourselves and do something about it 

And also workup for surgery so everyone’s not always immediately fit. But if you do the right diagnosis and right follow-ups. You can work up the patient, you can have better documentation of their findings from medical, legal perspectives. Also, and you can directly plan the surgery and call the patient only for the least exposure during the surgery.

5. Being an innovator if you can reminisce about any ‘Juggad technology’ used for any of your innovations.How was the experience?

Yeah, so see ‘Juggad’ is a part of the process of making an actual product. Juggad is what we would call in an innovation lingo, we would call it the first prototype or an alpha prototype or a proof of concept. Juggad is not at any point of time of final product but Juggad is a quick fix, where you prove your concept and show that it works. So it may not have the shape and form, it may be using some existing products or components are some quick means that you have made, and you’re able to achieve the outcome. So I think we do Juggad every invention that I have worked on. Our first step is to Juggad and that’s called a proof of concept was to create something using existing tools, without spending much money without spending much time and see whether this is working we don’t try this on patients but we try the concept, whether it is able to give a certain outcome, whether it’s a mechanical or the device that is producing certain pressure or producing certain temperature or it is it is maneuvering in certain ways, those kinds of things. I’ve done my job or my first innovation, where I was not experienced in inventing, and I was not trained in any of the training that I’ve got I’ve been trained by Stanford University through India Stanford partnership called Stanford India by design, we now do a lot of this Juggad very formally, but earlier my first experience with Juggad was when I was trying to make a portable laryngoscope I wanted to see inside the throat, but I wanted to see it portably. And this was back in 2008, so at that point of time we had digital cameras handheld cameras like your Sony Coolpix or any of those,  phones will not that advanced as they are today.

So my first Juggad was basically taping laryngoscope, video laryngoscope through the lens of the camera and seeing whether the same image is coming onto the screen and by taking another light source, like a portable light source and fixing it and I was able to perform endoscopies using that. Because what’s going inside the patient is still the laryngoscope and the recording system was a juggad and I think, when you do the juggad when you make that first prototype that’s when you start learning about what it needs to be in terms of the improved product it tells you a lot about what you’re doing right and what needs improvement and it is the right way to invent, it’s not like you have to get on a drawing board and think of the final perfect product and only make that you have to go through these iterations of making proof of concepts in a refined prototype than an even more refined prototype and you have to keep testing in between till you’re able to fix all the errors, make it a safe device and then take it for clinical trials. So I think, as an innovator, I feel juggad and developing technology is a very integral first step for any innovation

6. Can you give a brief description of your innovations and how it has benefitted community/patients.

Yeah so but before that, I would like to make it clear that not every invention I’ve worked on has been successful. Initially, I used to say I have developed three products or four products, and my teacher and guru Dr Ravi Nair who kind of coached me into innovation said job if you’re not getting the right picture.I said, But sir, I want to develop for products that are working, he’s like yeah but how many did you try to work on, and these four are the only ones that have survived. You are giving the message that any device you develop a successful. And then I started coming up with the statement where I would say, I worked on 12 devices, and five are in the market. And today I worked on about 20 devices in 10 are in the market, to show that there is a 50% failure.When you come to inventions, sort of the 10 devices or 10 technologies that have developed that are in the market. If I have to list some of them, then the first one of course is the ENT and endoscopy device that I was talking about in the previous answer. And this device was developed in 2008. But it took us a lot of time to refine it and bring it to the market. In fact, it took almost until 2014 for a large medical device company called Medtronic to license out the device and today it is what is called as a Shruti eye-ear program the device is called ENTraview so Shruti eye-ear is there screening device that it is now used for and I believe, close to about few I think 500 or 600,000 patients in rural parts of India have been screened.With the ENT review, and many hundreds of health workers have got jobs through the screening platform.

And so that is definitely one of the early technologies and that has reached massive number of people in terms of impact.The other couple of devices that I am an inventor of, but as an inventor what I would do is I would find the right engineering and design teams and then spin-off startup companies and then remain a clinical advisor so, with that, there is a device called SAANS, have you heard of you may have heard of it it’s, as it gets a lot of media coverage it’s a mechanical CPAP device so one of the original inventors, along with a team of I think 12 inventors, who are part of that technology but I think SAANS and SAANS pro have really impacted. Not only pediatric, transportation, while maintaining the positive air pressure of the lungs, but also in COVID it help patients who are having dropping oxygen saturations and providing them with the right pressures and there’s another device called pap care, which we also have a US-based and four and one of the original and mentors, but there’s another team that’s developing it and has brought it to commercialization.

This reduces a very crucial problem of ventilator-associated pneumonia. By ensuring that oral pharyngeal secretions and subplot executions are automatically cleared out without much neck movement without much need for nursing intervention so that less of the aspiration, less of the secretions aspirate into the lungs and cause pneumonia.Because the number of patients who are on ventilators they have a very high chance of getting into a ventilator. So the other devices in the empty space that we’ve made is a simple one is a nasal foreign body removal which is commercially available is already there in many medical colleges and hospitals and rural areas, which is a single simple handheld affordable device to remove anything impacted in the child nose from a non-end expert to any general practitioner Medical doctor, pediatrician who gets a child with the foreign body in the nose, where they don’t have any tool, they don’t have to use makeshift tools now we have a dedicated tool with a light source with a handle with the grip and with a unique mechanical design that can remove it in the first attempt. We have doctors putting videos of their first attempt removals on YouTube and many children are now avoided from having to undergo surgeries undergo anesthesia undergo endoscopic procedures, or have risk of aspiration into the lungs, because of the first point of care, the foreign bodies can be removed accurately.

Some of the other devices which are used very actively have developed a balloon sinuplasty system. Balloon sinuplasty system are not novel devices, they already exist, but they’re not so much in India because the cost the Western technologies, when they develop products, they price it based on their buyers. Most of the times, people who pay for these technologies are insurance companies, so they are exorbitantly high priced India as a out of pocket paying market. So, it didn’t make sense when some of these balloons sinuplasty devices came into India, namely Johnson and Johnson’s acclarant system was charged almost three times more than a very thorough fest procedure, which you would do for sinuses so it doesn’t make sense your patient will be like to put a balloon in my sinuses and, and do those procedures repeatedly, I might as well pay one third and get a get a definitive fest surgery. And for that reason didn’t work but we were able to reverse the economic economics here by making the balloon sinuplasty device, less than one third the cost of the first surgery so that in the opd, or as an office procedure people with early sinusitis can get a balloon dilation and reverse their sinus issues. And if they still, not recovering all the medications are not helping or there are other anatomical complications and they can undergo fest surgery but at least we avoid unnecessary fests in a large number of people and we avoid progression of disease, one in eight Indian suffer from sinusitis, and many of them can be provided non invasive minimally invasive very quick management earlier on.

Similarly, there is this, pressing problem of tinnitus and eustachian tube issues very common in India because of the turbinate enlargements and blockages of the Eustachian tube and we figured we have developed a balloon that can dilate the eustachian tubes and do both these procedures quite actively and it’s always overwhelming to use your own invention in your own practice that benefits your own patients, some of the others that we licensed out very quickly, were thoracocentrosis devices, abdominal paracentesis device, accurate meso gastric insertion tube, taken over by a company called Macman health in Delhi, and they are now distributing and manufacturing it in India and internationally.We also developed a liver biopsy device which is now developed under this company called India labs product, product is called bioscoop and that claims to do ultrasound based needle aspiration biopsy without causing any bleeding, which is a big problem because when you have liver disease, you’re interpreting reading is very high when you take to cut biopsies. These are some of the few devices that has reached the people over time.